A2 MILK: WHAT'S REAL AND WHAT DOES THE SCIENCE SAY? - DAVID DALLAS, PHD ASSISTANT PROFESSOR NUTRITION SCHOOL OF BIOLOGICAL AND POPULATION HEALTH ...

A2 milk: what’s real and
what does the science say?
                   David Dallas, PhD
                   Assistant Professor
                         Nutrition
   School of Biological and Population Health Sciences
      College of Public Health and Human Sciences
                 Oregon State University

A2 milk
• 2015: 9.3% of milk sold in Australia is A2.
   • Also increasing proportion of formula market
• Now in United States, China, New Zealand, UK
• Higher price point:
 Roughly $9/gallon vs. $5/gallon

A1 vs. A2 milk
• Amino acid polymorphism in beta-
  casein
  • One amino acid different (out of 209
    amino acids)
• Beta-casein makes up ~30% of cow
  milk protein
• Most cows produce a mix of A1 and
  A2 beta casein.
  • U.S. Holsteins are primarily A1.
    Guernsey almost all A2. Jersey and
    Brown Swiss have low A1.

Original claims
• A1 milk increases risk of type I diabetes and cardiovascular diseases,
  autism symptoms and many other diseases, but A2 milk doesn’t.
  (Elliott et al., 1999; McLachlan, 2001 )
   • Based on epidemiological evidence. Early findings led to formation of A2 milk
     company.
• Based on this evidence, the A2 milk company was suing other
  companies based on the claim that A1 milk was harmful to the
  consumer

Does A1 milk increase diabetes risk?
• Studies found epidemiologic association between
  type I diabetes and A1 consumption
   • 10 countries, type 1 diabetes incidence, A1 ratio in
     national herd, amount of milk protein produced for
     consumption
   • Mechanism: release of beta-casomorphin-7 from A1
     protein.
      • BCM-7 has immune suppressant effect, could be linked to type I
        diabetes development.
   • Correlation does not equal causation: Did not account
     for other factors
      • Confounding factors: other exposures, genetic predisposition,
        lifestyle, etc.

Does A1 milk increase diabetes risk?
• Mouse study found that A1 feeding increased diabetes incidence
  compared to A2 milk (Elliot 1997, not peer-reviewed).
• Later work to repeat the study found no effect of A1 milk (Beales,
  Elliott, 2002, peer-reviewed).

Does A1 milk increase cardiovascular disease
risk?
• Epidemiological country study found increased ischemic heart disease risk
  associated with increased A1 beta-casein consumption (Laugesen, Elliott
  2003).
   • did not account for confounding factors (caloric intake, other environmental
     exposures)
• Recent large studies found opposite conclusions
   • Two human intervention (feeding studies) studies found no correlation between
     cardiovascular disease biomarkers and A1 casein consumption (Chin-Dusting 2006,
     Venn 2006)
   • Cohort studies suggest milk consumption may lower heart disease and stroke risk
     (Elwood et al., 2004, 2005)
• No evidence that A1 casein can increase CVD risk in humans (De Noni,
  FitzGerald et al. 2009).

Does A1 milk increase autism symptoms?
• Papers said that milk opioid peptides in urine correlated with autism
  symptoms (Reichelt and Knivsberg 2003) .
• Evidence extremely poor. No peer-reviewed papers show this
  evidence clearly.
• Recent data does not support this relationship (De Noni, FitzGerald
  et al. 2009).

Does A1 milk increase risk for any disease?
• European Food Safety Authority report: no evidence for a cause-effect
  relationship between A1 milk and any disease (De Noni, FitzGerald et
  al. 2009)

Changes in A2 milk company claims
 • No longer makes claims about heart disease,
   type I diabetes or other diseases

 • New claims:
    • A1 milk can cause gastrointestinal discomfort. Some
      people who have trouble drinking regular milk may
      feel better drinking A2 milk.
       • Based on idea that A1 released BCM-7 whereas A2 does
         not.
    • On their website, claims that A1 beta-casein can
      cause inflammation in the gut

Can milk opioid peptides slow intestinal
transit time?
• Opioid peptides bind to opioid receptors in intestine
• Binding can increase mucus production and slow down passage rate
  through intestine (Daniel et al., 1990; Becker et al., 1990; Defilippi et
  al., 1995; Mihatsch et al., 2005).
• Opioid peptides presumed to be beneficial for infants by acting as an
  anti-diarrheal and increasing digestion efficiency
• BCM-7 is an opioid peptide, but less potent than endogenous and
  medicinal opioids.

Is BCM-7 released in A1 but not A2 milk?
• In vitro gastric and intestinal digestion studies suggest BCM-7
  release is much lower from A2 beta-casein than A1 beta-
  casein. Proline does make enzyme digestion more difficult at
  that site. (De Noni 2008; Cieślińska, Kostyra et al. 2012)
  (neither funded by the A2 milk company)
• Lack of in vivo studies. Effect of brush border peptidases not
  accounted for, one of which cleaves BCM-7 at high rate. No
  proof that BCM-7 is released more from A1 in vivo, or that it
  survives intact longer than it would for A2

• Overall: it is likely that A1 beta-casein releases more BCM-7
  than A2 beta-casein, but more evidence in vivo is needed
• Note: both A1 and A2 milk contains many other opioid
  peptides

Can A1 milk alter digestion?
• In rats, feeding A1 beta-casein led to slower GI transit than A2, difference
  could be eliminated by opioid blocking drug (Barnett, McNabb et al. 2014)
  (funded by A2 milk company)
• In humans, feeding A1 milk led to significantly higher consistency stools
  than A2 milk. (Ho, Woodford et al. 2014) (funded by A2 milk company)
   • Clinically relevant? 3.87 on A1 to 3.56 on A2 on a 1-9 stool consistency scale.
   • No differences in bowel frequency
   • Bloating, abdominal pain, flatus not significantly different.

• Is the research trustworthy?
   • Needs replication with non-biased funding
• Is the difference clinically relevant?

Can A1 milk cause inflammation?
• Claimed on company website in multiple places
• No difference in inflammatory markers (fecal calprotectin) for humans
  fed A1 or A2 milk (Ho, Woodford et al. 2014) (funded by A2 milk
  company)
• No evidence for this—studies show no difference in inflammatory
  markers (even studies paid for by the A2 milk company)

Bottom line
• A2 milk sales are increasing and are sold at higher prices
• Does A2 milk decrease risk for cardiovascular disease, type I diabetes,
  and autism? NO good evidence
• Is BCM-7 release higher from A1 milk in vitro? Yes.
• Is BCM-7 release and survival higher from A1 milk in vivo? Unknown.
• Does A2 milk decrease gut inflammation? NO evidence
• Does A2 milk decrease the likelihood of constipation? Possibly, but
  needs more research with non-biased funding.
• Is consuming A2 milk problematic? No

Questions for follow-up research
• Are cheeses, yogurts, kefir, etc. digested differently, altering the
  potential affects of A1 vs. A2 milk?
   • No good research currently.
• Is BCM-7 released in the adult gut? How long does it stay intact?
  Differences between A1 and A2 milk?
• Are there different consumers for which A1 vs. A2 milk are more
  appropriate? For example those with diarrhea may benefit from the
  potential slowing effects of A1 BCM-7.

Questions and Comments?

                  dave.dallas@oregonstate.edu
                 www.dallaslab.org

Can BCM-7 be absorbed and have systemic
effects?
• Opioids can have a pain reducing effect (analgesic), but must cross
  the blood-brain barrier
• The blood-brain barrier has a receptor for opioids called PTS-1
• BCM-7 immunoreactive material found in plasma of 2 and 4-week old
  puppies after feeding bovine casein and in newborn calves. But the
  peptide was much longer (more AA) than BCM-7 by MS. BCM7 is
  rapidly degraded in plasma by blood peptidases (Singh 1989; Umbach
  1985).
• Injection of BCM7 into the central nervous system in rats can cause
  analgesia, but never observed from oral intake.